杨林承,米琳,于海奕,高炜,祖凌云

• 1:北京大学第三医院心内科血管医学研究所血管稳态与重构全国重点实验室国家卫健委心血管分子生物学与调节肽重点实验室心血管受体研究北京市重点实验室

摘要(Abstract)：

目的 探究接受直接经皮冠状动脉介入治疗（PPCI）的急性前壁心肌梗死患者，术后血前蛋白转化酶枯草溶菌素9(PCSK9)水平与严重冠状动脉微循环功能障碍（CMD）间的相关性。方法 从PUUMA-MI研究中，回顾性纳入2013年1月至2016年8月就诊于北京大学第三医院，并符合研究条件的接受PPCI的急性前壁心肌梗死患者96例作为研究对象。从生物标本库中获取留存的患者血液标本，通过酶联免疫吸附测定检测患者PPCI后血基线PCSK9水平。从北京大学第三医院心内科导管室服务器中获取入组患者PPCI后冠状动脉造影影像，计算术后即刻冠状动脉造影衍生的微循环阻力指数（Angio-IMR），并将研究对象按Angio-IMR分为无严重CMD组及合并严重CMD组。收集研究对象在院期间及出院后1年内的临床资料，记录PPCI术后1年内主要不良心血管事件发生情况、PPCI术后1年内心力衰竭再入院情况与术后1年超声心动图结果。两组间比较患者血PCSK9水平，分析血PCSK9水平与合并严重CMD间的关系，比较两组患者的临床预后、心脏结构与功能差异情况。结果 PPCI后合并严重CMD组患者与无严重CMD组比较，年龄更大[（64.5±10.1）岁比（57.9±12.7）岁]、血基线PCSK9水平更高[（323.3±80.9）ng/ml比（272.2±86.1）ng/ml]，术后1年LVEF<50%者比例（42.3%比20.0%）及发生左心室重构者比例（50.0%比15.7%）更高，差异均有统计学意义（均P<0.05）。PPCI后合并严重CMD组患者术后1年内主要不良心血管事件发生率及心力衰竭再入院率略高，但与无严重CMD组比较，差异均无统计学意义（均P>0.05）。经多因素Logistic回归后退法验证，PPCI后血PCSK9高水平为患者术后合并严重CMD的独立危险因素（OR 1.007,95%CI 1.002～1.013,P=0.012）；相关性分析表明，血PCSK9水平与术后即刻Angio-IMR显著正相关（r=0.207,P=0.043）。结论 PCSK9与急性前壁心肌梗死患者PPCI术后合并严重CMD相关。

关键词(KeyWords)： 前蛋白转化酶枯草溶菌素9;急性心肌梗死;冠状动脉微循环功能障碍

Abstract:

Keywords:

基金项目(Foundation): 北京市自然科学基金外籍学者资助项目（IS24047）

作者(Author): 杨林承,米琳,于海奕,高炜,祖凌云

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